The Western Balkans Regulation in nursing and healthcare

2.Legal basis — Section 26(2) BeschV

The conditions set out in the provision itself, in summary:

Priority check (Vorrangprüfung)

The text of the ordinance provides for a priority check. According to the association GGUA, an instruction of the Federal Employment Agency (Weisung 202311002) has suspended it “until further notice” since November 2023 for the Western Balkans Regulation. Handwerksblatt reported the same in May 2024, citing the German Confederation of Skilled Crafts (ZDH). The Federal Employment Agency's own page on the regulation does not mention this, so the source is secondary.

3.What it means for nurses and care work

Germany distinguishes between the qualified nurse (Pflegefachkraft — a regulated profession) and the nursing assistant (Pflegehilfskraft). Which legal route applies depends on the work the person will do:

• For nursing assistants, the Federal Employment Agency also points to other legal bases that are not subject to a quota, so a request can be processed faster once the monthly or annual Western Balkans quota is used up.
• Under a recognition partnership, in regulated professions (for example nurse or doctor) assistant work is permitted until the licence to practise is issued.
• According to the federal government, at the end of 2024 2,610 people holding a residence title under the Western Balkans Regulation worked in nursing occupations (4.3% of all holders of that title), and 3,364 in health and social care overall.
• In May 2025 about 51,000 people from the Western Balkan countries were employed in nursing and care across all legal bases — almost five times as many as in 2015.

Recognition partnership — requirements

• Qualification: a foreign university degree, or a vocational qualification following at least two years of full-time training, recognised by the state in the country where it was obtained. Proof is the ZAB's positive statement on the vocational qualification; for degrees, a statement of comparability or a positive rating in the anabin database.
• Job offer: a specific offer from an employer in Germany, as a rule for skilled employment. In regulated professions, assistant work is allowed until the licence to practise is granted.
• Agreement: a written agreement with the employer that the recognition procedure will be made possible within the employment relationship; it may form part of the employment contract.
• Language: German at level A2 at least; some qualification measures may require a higher level depending on the profession.
• Employer: must have experience with vocational training or post-qualification. Working conditions must match those of domestic employees, and the Federal Employment Agency must approve.
• Duration: the residence title is first issued for up to 12 months and extended one year at a time, up to a maximum of three years. A secondary job of up to 20 hours a week is permitted alongside.
• After recognition: with full equivalence, the next step is a residence permit as a skilled worker or an EU Blue Card (the Blue Card does not apply to nursing professionals). With partial equivalence, the title is extended by up to two years, tied to qualification measures which the employer must make possible.

Nursing assistant under Section 22a BeschV

• A specific job offer as a nursing assistant in Germany, ideally an employment contract that has already been signed.
• Nursing-assistant training completed in Germany or a foreign care qualification recognised in Germany as Pflegehilfskraft. This means nursing training of less than three years.
• The Federal Employment Agency checks that working conditions match those of German nursing assistants. Its approval is obtained between the authorities during the visa procedure.
• The residence permit is issued for the duration of the employment contract plus three months; for a permanent contract, for a maximum of four years.

Recognition as a qualified nurse

• The application goes to the competent authority of the federal state where the person will work; the recognition it grants is valid throughout Germany. The procedure usually takes 3 to 4 months.
• There are two routes: an equivalence assessment based on the documents, or waiving that assessment and going straight to a compensatory measure (knowledge test or adaptation course). The waiver can shorten the procedure and reduce fees, but earlier qualifications and professional experience are then not taken into account, so the test or course may be more extensive.
• There is a right to advice before deciding; the Central Service Point for Professional Recognition (Zentrale Servicestelle Berufsanerkennung, ZSBA) advises free of charge.
• Besides the recognised qualification, German at level B2 at least, proof of medical fitness and proof of a clean criminal record are required.
• If the qualification has not been fully recognised, a visa for the recognition of foreign professional qualifications can be applied for, so that the qualification measures are completed in Germany.
• If the qualification is not recognised as that of a qualified nurse, recognition as a nursing assistant can be applied for.
• The EU Blue Card does not apply to nursing professionals.

4.The procedure step by step

5.Documents for the visa — embassy in Belgrade

According to the embassy's page (published on 5 February 2026):

• VIDEX form for a long-term stay, completed online and signed by hand
• Passport: valid for at least 3 months beyond the planned entry, with at least 2 blank pages; with copies
• 2 identical biometric photos, no older than 6 months
• Advance approval from the BA (original or copy)
• Erklärung zum Beschäftigungsverhältnis — the employer's declaration submitted with the application for advance approval
• Employment contract (original and copy)
• For nursing assistants: proof of German at level B1 — a certificate from the Goethe-Institut, ECL or ÖSD; telc only if the exam was taken in Germany. For other work, language skills are not required in principle, but may be requested for jobs involving contact with customers.
• From age 45: proof of adequate pension provision — a sufficiently high salary, or evidence of pension entitlements, insurance and assets, translated by a court-certified interpreter
• Signed declarations and notices, including the declaration on private health insurance until statutory cover begins

In addition to the visa fee, Visametric charges a service fee of €40 (payable in Serbian dinars). Statutory health insurance only begins once residence is taken up and work starts; anyone entering earlier needs private health insurance until then. Family members each apply for their own national visa; visa-free entry or entry on a Schengen visa is not possible for this purpose.

Anyone whose qualification is recognised as Pflegehilfskraft and who enters on that basis prepares the documents according to the embassy's separate checklist for care staff.

6.Requirements for employers and quotas in practice

• Working conditions must match those of a comparable employee in Germany, and the salary must cover living costs.
• For employees over 45 receiving approval for the first time: a gross annual salary of at least €55,770 (55% of the 2026 contribution assessment ceiling in the general pension scheme) or proof of adequate pension provision.
• The annual quota is divided into monthly quotas by nationality. They are set for the Federal Employment Agency, which cannot change them; applications are processed only while the monthly quota for that nationality has not been used up.
• The accelerated procedure for skilled workers (beschleunigtes Fachkräfteverfahren), which the employer can initiate for a separate fee, cannot be used for entry under the Western Balkans Regulation.
• For employers' questions the Federal Employment Agency runs a free hotline: +49 228 713 2000.

The annual quota for 2025 was used up at the beginning of December 2025 (Federal Employment Agency, reported by the Baugewerbe-Verband Niedersachsen). Rejected applications are not carried over to the following year; new ones could be filed from January 2026.

7.The quota: history and planned changes

Visas under the regulation, by year

Visa applications under the Western Balkans Regulation, all countries together, according to the federal government's answer to the Bundestag. Rejections have only been recorded since 2018.

At the end of 2024, 61,171 people held a job in Germany with a residence permit under the Western Balkans Regulation, most of them in construction (36.3%) and hospitality (14.8%); health and social care accounted for 5.5%.

8.Sources

The information on this page comes from these sources. The links lead to pages in German.

1. 1.Section 26 BeschV — Western Balkans Regulation (subsection 2), text of the ordinance (German)gesetze-im-internet.de
2. 2.Section 22a BeschV — nursing assistants, text of the ordinance (German)gesetze-im-internet.de
3. 3.Bundesagentur für Arbeit — Westbalkanregelung (processing status of 14 October 2026)arbeitsagentur.de
4. 4.German Embassy Belgrade — Arbeiten ohne Fachqualifikation. Die Westbalkanregelung (5 February 2026)belgrad.diplo.de
5. 5.Make it in Germany — information sheet on the Western Balkans Regulation (as of July 2025)make-it-in-germany.com
6. 6.Make it in Germany — Sonderregelung für Pflegehilfskräftemake-it-in-germany.com
7. 7.Make it in Germany — Visum zur Anerkennungspartnerschaftmake-it-in-germany.com
8. 8.Make it in Germany — Pflegekräfte: recognition and entrymake-it-in-germany.com
9. 9.Deutscher Bundestag, Drucksache 21/1126 (4 August 2025) — Arbeitskräftezuwanderung über die Westbalkanregelungdserver.bundestag.de
10. 10.GGUA — Keine Vorrangprüfung bei Westbalkan- und Best-Friends-Regelung (19 November 2024)ggua.de
11. 11.Handwerksblatt — Chancenkarte und Westbalkan-Regelung: Das ändert sich ab 1. Juni (31 May 2024)handwerksblatt.de
12. 12.Baugewerbe-Verband Niedersachsen — Jahreskontingent 2025 der Westbalkanregelung ausgeschöpft (2 December 2025)bvn.de
13. 13.Deutsche Handwerks Zeitung — Baugewerbe warnt vor 8.000 fehlenden Arbeitskräften (24 September 2026)deutsche-handwerks-zeitung.de
14. 14.BVMB — criticism of the cut to the Western Balkans Regulation (9 October 2026)pressebox.de
15. 15.Handwerksblatt — Westbalkanregelung: nur noch halb so viele Erlaubnisse (6 August 2025)handwerksblatt.de
16. 16.Anerkennung in Deutschland — the recognition procedure and how long it takesanerkennung-in-deutschland.de

Please note: This page is for information only and is not legal advice. The details summarise legislation and official pages (Federal Employment Agency, the embassy in Belgrade, Make it in Germany, the Bundestag) as of 13 October 2026. Where a source is secondary (trade press, associations), this is stated. Before applying, check the current position with the Federal Employment Agency and the embassy.